Reflective accounts

Pulmonary oedema

A CPD article improved Monica Thompson’s knowledge of the assessment and management of acute pulmonary oedema.
Nurse views lung X-ray

A CPD article improved Monica Thompsons knowledge of the assessment and management of acute pulmonary oedema

What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice?

The CPD article discussed acute pulmonary oedema, which is the build-up of excess fluid in the lungs. It is a life-threatening illness that should be treated as a medical emergency.

What did you learn from the CPD activity and/or feedback and/or event or experience in your practice?

The article stated that pulmonary oedema is diagnosed based on the patients presentation, which generally includes: sudden onset of dyspnoea, especially when lying down; rales (rattles or crackles) present on auscultation; and oxygen desaturation.

Early recognition, accurate assessment and appropriate management are essential to prevent deterioration and improve patient outcomes. The ABCDE (airway, breathing, circulation, disability, exposure) approach

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A CPD article improved Monica Thompson’s knowledge of the assessment and management of acute pulmonary oedema

What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice?

The CPD article discussed acute pulmonary oedema, which is the build-up of excess fluid in the lungs. It is a life-threatening illness that should be treated as a medical emergency.

What did you learn from the CPD activity and/or feedback and/or event or experience in your practice?

The article stated that pulmonary oedema is diagnosed based on the patient’s presentation, which generally includes: sudden onset of dyspnoea, especially when lying down; rales (rattles or crackles) present on auscultation; and oxygen desaturation.

Early recognition, accurate assessment and appropriate management are essential to prevent deterioration and improve patient outcomes. The ABCDE (airway, breathing, circulation, disability, exposure) approach should be used to assess patients. Diuretics and vasodilators are first-line treatments for people with acute pulmonary oedema, while nursing care focuses on optimising oxygenation, monitoring, triage and planning discharge.

The article outlined the causes of pulmonary oedema. I have learned that the most common cause of pulmonary oedema is increased pressure in the capillaries, which could be precipitated by increased intravascular volume from over-transfusion of fluids and renal failure, or by the redistribution of blood volume or flow.

How did you change or improve your practice as a result?

Reading the CPD article has improved my understanding of acute pulmonary oedema. The article emphasised the importance of communication, adopting a multidisciplinary approach and long-term patient management, which I can implement in my practice. Patients with pulmonary oedema are usually distressed, and in the past, were given opiates to provide relief. However, I am now aware opiates should not be given routinely to patients with acute pulmonary oedema. Timely management and assessment, as well as good communication, are more likely to ease distress.

Developing greater understanding of the patient experience will enhance compassionate care. Patients should also have a structured self-management plan in place when they are discharged, and be informed of the signs of reoccurrence.

The article stated that a fluid-balance chart should be used to monitor a patient’s urine output. I have discussed the importance of monitoring observations with the students I mentor and will continue to encourage the accurate completion of
fluid-balance charts. The article has prompted me to organise a teaching session for my colleagues about pulmonary oedema.

How is this relevant to the Code? Select one or more themes: Prioritise people, Practise effectively, Preserve safety, Promote professionalism and trust

One of the themes of The Code is to practise effectively, which involves working cooperatively with others. The article identified that a multidisciplinary approach and effective communication are crucial to prevent patients with pulmonary oedema from deteriorating. It is also important for nurses to keep their knowledge and skills up to date. Reading this article has updated my knowledge of acute pulmonary oedema, including its symptoms and treatment.

The Code states that nurses must prioritise people. Treatment of pulmonary oedema should be patient-centred and enable individuals to make informed decisions about their care.

Monica Thompson is a theatre/recovery team leader at Nuffield Health Bournemouth Hospital, Bournemouth


This reflective account is based on NS829 Powell J et al (2016) Acute pulmonary oedema. Nursing Standard. 30, 23, 51-59. These questions are the same as those on the NMC templates that UK nurses and midwives must use for revalidation

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